Elsevier: Goodman & Snyder: Differential Diagnosis for ...



Goodman & Snyder: Differential Diagnosis for Physical Therapists,

5th Edition

Chapter 13: Screening for Cancer

Practice Questions

1. Name three predisposing factors to cancer that the therapist must watch for during the interview process as red flags.

2. How do you monitor exercise levels in the oncology patient without laboratory values?

3. In a physical therapy practice, clients are most likely to present with signs and symptoms of metastases to:

a. Skeletal system, hepatic system, pulmonary system, central nervous system

b. Cardiovascular system, peripheral vascular system, enteric system

c. Hematologic and lymphatic systems

d. None of the above

4. What is the significance of nerve root compression in relation to cancer?

5. Complete the following mnemonic:

C

A

U

T

I

O

N

S

6. Whenever a therapist observes, palpates, or receives a client report of a lump or nodule, what three questions must be asked?

7. How can the therapist determine whether a client’s symptoms are caused by the delayed effects of radiation as opposed to being signs of recurring cancer?

8. Give a general description and explanation of the changes seen in deep tendon reflexes associated with cancer.

9. Why is weight loss a significant red flag sign in a physical therapy practice?

10. When tumors produce signs and symptoms at a site distant from the tumor or its metastasized sites, these “remote effects” of malignancy are called:

a. Bone metastases

b. Vitiligo

c. Paraneoplastic syndrome

d. Ichthyosis

11. A client who has recently completed chemotherapy requires immediate medical referral if he has which of the following symptoms?

a. Decreased appetite

b. Increased urinary output

c. Mild fatigue but moderate dyspnea with exercise

d. Fever, chills, sweating

12. A suspicious skin lesion requiring medical evaluation has:

a. Round, symmetric borders

b. Notched edges

c. Matching halves when a line is drawn down the middle

d. A single color of brown or tan

13. What is the significance of Beau’s lines in a client treated with chemotherapy for leukemia?

a. Impaired nail formation from death of cells

b. Temporary longitudinal groove or ridge through the nail

c. Increased production of the nail by the matrix as a sign of healing

d. A sign of local trauma

14. A 16-year-old boy was hurt in a soccer game. He presents with exquisite right ankle pain on weight bearing but reports no pain at night. Upon further questioning, you find he is taking Ibuprofen at night before bed, which may be masking his pain. What other screening examination procedures are warranted?

a. Perform a heel strike test.

b. Review response to treatment.

c. Assess for signs of fracture (edema, exquisite tenderness to palpation, warmth over the painful site).

d. All of the above

15. When is it advised to take a work or military history?

a. Anyone with head and/or neck pain who uses a cell phone more than 8 hours/day

b. Anyone over age 50

c. Anyone presenting with joint pain of unknown cause accompanied by multiple other signs and symptoms

d. This is outside the scope of a physical therapist’s practice

16. A 70-year-old man came to outpatient physical therapy with a complaint of pain and weakness of his fingers and morning stiffness lasting about an hour. He presented with bilateral swelling of the metacarpophalangeal (MCP) joints of the index and ring fingers. He saw his family doctor 4 weeks ago and was given diclofenac, which has not changed his symptoms. Now he wants to try physical therapy. Since he last saw his physician, he has developed additional joint pain in the left knee and right shoulder. How can you tell if this is cancer, polyarthritis, or a paraneoplastic disorder?

a. Ask about a previous history of cancer and recent onset of skin rash.

b. You can’t. This requires a medical evaluation.

c. Look for signs of digital clubbing, cellulitis, or proximal muscle weakness.

d. Assess vital signs.

17. A 49-year-old man was treated by you for bilateral synovitis of the proximal interphalangeal (PIP) joints in the second, third, and fourth fingers. His symptoms went away with treatment, and he was discharged. Six weeks later, he returned with the same symptoms. There was obvious soft tissue swelling with morning stiffness worse than before. He also reports problems with his bowels but isn’t able to tell you exactly what’s wrong. There are no other changes in his health. He is not taking any medications or over-the-counter drugs and does not want to see a doctor. Are there enough red flags to warrant medical evaluation before resumption of physical therapy intervention?

a. Yes; age, bilateral symptoms, progression of symptoms, report of GI distress

b. No; treatment was effective before—it’s likely that he has done something to exacerbate his symptoms and needs further education about joint protection.

18. A client with a past medical history of kidney transplantation (10 years ago) has been referred to you for a diagnosis of rheumatoid arthritis. His medications include tacrolimus, methotrexate, Fosamax, and Wellbutrin. During the examination, you notice a painless lump under the skin in the right upper anterior chest. There is a loss of hair over the area. What other symptoms should you look for as red flag signs and symptoms in a client with this history?

a. Fever, muscle weakness, weight loss

b. Change in deep tendon reflexes, bone pain

c. Productive cough, pain on inspiration

d. Nose bleeds or other signs of excessive bleeding

19. A 55-year-old man with a left shoulder impingement also has palpable axillary lymph nodes on both sides. They are firm but movable, about the size of an almond. What steps should you take?

a. Examine other areas where lymph nodes can be palpated.

b. Ask about history of cancer, allergies, or infections.

c. Document your findings and contact the physician with your concerns.

d. All of the above

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